Hospitals scramble on the front lines of drug shortages

The situation was urgent. The operating room and many key units at MedStar Washington Hospital Center were running low on a critical anesthetic. Suppliers were out of the most commonly used dosages. The only remedy was for pharmacy staffers to dilute a higher concentration with saline solution to produce the needed strength.

Ann Breakenridge, an assistant pharmacy director, needed action immediately. “We have an acute shortage situation,” she told Renee McCarthy, who oversees the lab. “I need somebody to make some midazolam syringes, like yesterday.”

(The Washington Post/University of Utah Drug Information Service) - Drug shortages are still rising despite Food and Drug Administration efforts to curb them.

On that recent Tuesday, technicians filled 400 syringes with the anesthetic, enough to last an additional two or three days. The painstaking process took more than four hours.

“And it’s just one drug,” Breakenridge said. “You sit there and you’re like, ‘Wow.’ ”

Shortages of prescription drugs have been a growing concern for the past six years. They nearly tripled from 2005 to 2010 and reached record levels in 2011 as manufacturers ceased operations or ran into production problems. The Food and Drug Administration has been scrambling to respond, helping firms resume production more quickly and approving emergency imports of supplies. Recent approvals of new suppliers helped ease shortages of two crucial cancer drugs.

In some cases, lifesaving treatments have been delayed, sending patients on desperate searches for needed medicines, doctors say. Shortages have also caused injuries from mistakes and at least 15 deaths around the country since mid-2011, according to the Institute for Safe Medication Practices, a nonprofit that tracks medication errors. The mistakes included confusion about dosing and preparation of substitutes.

Shortfalls are so common that pharmacy staffers at hospitals are spending many extra hours to ensure an uninterrupted flow of medicine to cancer patients, victims of heart attacks and accidents, and a host of other ill people.

“It’s very, very time-consuming, and it involves a lot of people,” Breakenridge said, referring to the multiple steps needed to manage each shortage. “It impacts operations tremendously. And it’s just to try to make sure that the patient comes in and everything is seamless for them.”

More than 210 drugs are in short supply or totally unavailable, according to Bona Benjamin of the American Society of Health-System Pharmacists. The majority are generic injectable medications widely used in hospitals, including drugs used to relieve pain, fight cancer or infections, anesthetize surgical patients, treat cardiovascular disease, and manage psychiatric conditions.

Critical intravenous nutritional supplements and drugs for controlling attention-deficit hyperactivity disorder are also hard to find, according to the pharmacists group.

Most hospitals rarely get advance notice of the shortages, explanations of what caused them or estimates of how long they will last. So pharmacists scramble. They repackage higher concentrations into smaller doses. They find substitutes, which can often be more expensive. They ration drugs.